Supporting Medical Conversations Between Deaf and Hearing Individuals with Tabletop Displays Anne Marie Piper and James D
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Supporting Medical Conversations between Deaf and Hearing Individuals with Tabletop Displays Anne Marie Piper and James D. Hollan Distributed Cognition and Human-Computer Interaction Laboratory Department of Cognitive Science, University of California, San Diego 9500 Gilman Dr., La Jolla, CA 92093 {apiper, hollan}@ucsd.edu ABSTRACT language interpreter to facilitate communication between a This paper describes the design and evaluation of Shared deaf patient and hearing doctor. Deaf patients must plan Speech Interface (SSI), an application for an interactive ahead to ensure that an interpreter is available. For most multitouch tabletop display designed to facilitate medical patients, privacy is a central concern. Some deaf patients, conversations between a deaf patient and a hearing, non- depending on their comfort level with interpreters, prefer signing physician. We employ a participatory design and actually use an alternate communication channel (e.g., process involving members of the deaf community as well email or instant messenger to discuss sensitive medical as medical and communication experts. We report results issues with their physician). Increasing communication from an evaluation that compares conversation when privacy is one motivation behind the work reported here. facilitated by: (1) a digital table, (2) a human sign language While other viable communication tools for the deaf interpreter, and (3) both a digital table and an interpreter. community exist, tabletop displays with speech recognition Our research reveals that tabletop displays have valuable have potential to facilitate medical conversations between properties for facilitating discussion between deaf and deaf and hearing individuals. Consultations with physicians hearing individuals as well as enhancing privacy and often involve discussion of visuals such as medical records, independence. The contributions of this work include initial charts, and scan images. Interactive tabletop displays are guidelines for cooperative group work technology for users effective for presenting visual information to multiple with varying hearing abilities, discussion of benefits of people at once without necessarily designating one person participatory design with the deaf community, and lessons as the owner of the visual. Taking notes while meeting with about using dictated speech on shared displays. a physician is problematic for deaf individuals because it Categories and Subject Descriptors requires simultaneously attending to the doctor’s facial H.5.3 [Information Interfaces and Presentation (e.g., expressions, the interpreter’s visual representation of HCI)]: Group and Organization Interfaces - Computer- speech, and notes on paper. A tabletop display allows all supported cooperative work. active participants to maintain face-to-face contact while General Terms viewing a representation of conversation in a central Design, Experimentation, Human Factors. location. Our implementation incorporates keyboard input by the patient and speech input by the doctor, allowing the Keywords physician to speak and gesture as they discuss medical Computer-supported cooperative health care, multitouch, details and visuals with the patient. SSI leverages the tabletop groupware, assistive technology, deafness, affordances of multimodal tabletop displays to enhance multimodal interfaces, speech recognition. communication between a doctor and patient, potentially INTRODUCTION transforming a challenging situation into a constructive and This paper presents the design and evaluation of Shared collaborative experience. Speech Interface (SSI), an application for an interactive Our work on SSI provides practical experience designing a tabletop display that enables and supports communication shared communication device for users with varying between a deaf patient and a hearing, non-signing medical hearing and speaking abilities. We examine the challenges doctor. Currently, medical facilities provide a sign of representing speech visually to multiple users around a tabletop display. We also provide design guidelines for using dictated speech with shared display systems and discuss the implications of our work on multimodal tabletop displays for the broader CSCW community. BACKGROUND Loss of hearing is a common problem that can result from noise, aging, disease, and heredity. Approximately 28 million Americans have significant hearing loss, and of that group work for only hearing populations and have yet to group, almost six million are profoundly deaf [17]. A examine the value of tabletop displays for deaf populations. primary form of communication within the United States Technologies for the Deaf deaf community is American Sign Language. ASL is not a As early as 1975, researchers began investigating how visual form of English; it is a different language with its cooperative computing environments, such as early forms own unique grammatical and syntactical structure. Sources of instant messenger, could facilitate communication estimate that ASL is the fourth most commonly used between deaf and hearing individuals [27]. More recently, language in the U.S. [17]. While ASL is widely used in the HCI researchers have examined how mobile devices, tablet U.S., no one form of sign language is universal. Different computers, and video conferencing technologies can countries and regions use different sign languages. For augment communication for deaf individuals. Schull example, British Sign Language is different from American investigated communication via a browser-based client on Sign Language, although both countries have English as multiple co-located laptops that allows a deaf and hearing their official and primary spoken language. user to access a common browser window and share real- Within the deaf community, as with most communities, time chat information [21]. iCommunicator [7], a there is great variability among individual needs and commercial product, enables communication in a similar abilities. Individuals who were born deaf may or may not way. Only a handful of initiatives, however, have attempted have been raised in the aural tradition where they were to facilitate shared face-to-face communication taught to speak, read, and write in English. Others who experiences. The majority of work has focused on single- suffer from late-onset hearing loss typically have fully user interfaces for distributed applications. For example, developed vocal abilities but are not fluent in ASL and do MobileASL enables two signing individuals to not know how to read lips. This range of individual abilities communicate with each other over cell phones with real and needs has lead to a gamut of techniques for time video [1]. Scribe4Me, a mobile sound translation tool, communicating with and adapting to the hearing world. enables deaf individuals to request a transcription of the Adaptive Techniques past 30 seconds of audio in their environment [10]. There is For the deaf population proficient in a spoken language also work using peripheral displays to visualize various such as English, writing has long been a central form of channels of auditory information for deaf individuals [11]. communication with the hearing world. Deaf individuals The Facetop Tablet project examined visual attention without an interpreter nearby often use handwritten notes problems that deaf individuals experience when trying to and deictic gesturing as a means of communication. view a presentation, watch an ASL interpreter, and take Telephone use was impossible for the deaf community until notes [13]. This project presents a viable approach for the invention of the Teletype and Text Telephone (TTY), a helping deaf individuals follow a conversation with hearing typing-based system that transmits individual lines of individuals but it does not explicitly help deaf individuals keyboard entry over phone lines. Adoption of the TTY and communicate or become active participants in the eventually the personal computer made typing an essential conversation. Past research has also examined enhancing mode of communication within the deaf community. In communication for deaf individuals through gesture recent years, the invention of webcams and increasing recognition with computer vision and wearable computers Internet bandwidth gave rise to communication through (e.g., [24]). videochat with other ASL speakers and ASL interpreters. While these solutions address various communication ASL interpreters play a central role in enabling face-to-face challenges for deaf individuals, none provide a shared communication between many deaf and hearing communication experience that bridges both speaking and individuals. For the deaf population fluent in ASL, listening barriers between deaf and hearing individuals. communicating through an interpreter is an optimal choice Furthermore, many of these communication technologies for many situations. Interpreters, however, are expensive only provide an interface and feedback to one user. Our and not always available. Furthermore, though interpreters system, on the other hand, leverages the cooperative nature are bound by a confidentiality agreement, the presence of a of interactive tabletop displays to enable a shared, co- third person in a highly private conversation may reduce a constructed communication experience between users with deaf person’s comfort and inhibit their willingness to speak varying hearing and speaking abilities. candidly. Tabletop Displays Related Work The field of CSCW has a rich